Meeting Summary: June 1, 2006
Chair: Paula Armbruster
Next meeting: Wednesday July 12 @ 1 PM in LOB RM. 3800

Department of Public Health Statewide Perinatal Depression Initiative

Lisa Davis (DPH) provided an overview of the department's perinatal initiative that seeks to enhance public awareness of perinatal depression. Ms. Davis, Dr. Neill Epperson, Brenda Kurtz and Amy Gagliardi, participants in the DPH forum on this topic, discussed aspects of perinatal depression, patient response to seeking treatment and possible vehicles to disseminate information about perinatal depression.

• Social marketing strategies were discussed; only about a third of recipients of preventive care services said they did so because of printed material, so brochures may not be an effective primary strategy.
• MCOs were interested in receiving printed information from DPH to disseminate to members and possible follow up focus groups to gauge how people respond to member mailings. Also interested in including information about perinatal depression in quarterly provider newsletters.
• DPH considering posters to local health depts., FQHCs and VNAs.
• DPH is using some federal dollars for two depression screening pilots at the Bridgeport and CHC, Inc clinics. At the CHC clinic, an MSW is doing the screens, and scoring the responses. Dr. Epperson noted it is important to assess social economic status factors versus mental health aspect of the screen responses.
• In HUSKY program:

o CHNCT has revamped their perinatal program and is considering a depression disease management program that could include depression associated with asthma and pregnancy.
o The behavioral health partnership (BHP) Administrative Service Organization, Value Options, has included depression during or after pregnancy in the criteria for intensive care management (ICM) by VOI/CTBHP. In this program, there is coordinated care management between the MCO and VOI/CTBHP
o Brenda Kurtz (UCONN) talked about her work with the Hispanic Health Council in identifying the key barriers for Hispanic women to accept MH services. There are known basic barriers that include insurance coverage, SES, cultural variables, stigma associated with depression/pregnancy, domestic violence, BH service availability.
o Dr. Epperson noted that Dr. Mark Schaefer (DSS) discussed the potential inclusion of primary care/psychiatry consultation via phone in the BHP program at the DPH conference. This would allow medical clinicians to receive advice from psychiatry via phone; there are challenges to systematizing this.
o Could telemed technology, especially with linguistic capabilities, assist practitioners in BH assessment and interventions? Dr. Epperson noted that Montana has used telemed technology for medical and behavioral health services.

Health Plan Perspective on OBGYN Registration Forms

The subcommittee chair had asked the MCOs to informally discuss how they can use the maternal risk information on the standard OBGYN registration forms that both commercial and Medicaid plans are now using. The MCOs concurred that while the forms register the member for pregnancy-related services, few forms include risk factor information. The plans rely on member contact to assess pregnancy risk factors once the registration form is received. CHNCT noted they also review claims data for medical/BH needs and pharmacy utilization to identify pregnancy case management needs.

The Chair asked how the SC/Council could support the collection of risk data on the forms. The plans will review the data received over the next several months and bring information back to the SC for further discussion.

Emergency Room Utilization MCO data
WellCare/PONE and Anthem provided information about their ED non-emergent/emergent utilization patterns.
WellCare/PONE

• In the last quarter of 2005, approximately 1% of the plan population had 5 visits over a 6 month period.
• Of the ED visits, 56% were emergent, 44% were non-emergent. The top ED diagnostic code was viral infections, with screens for streptococcus infection.
• The MCO observed that:

o The plan has a 24-hour nurse line that is underutilized by members. The health plan was only able to contact 3 of 118 members for follow up (see if they need connection to a PCP, etc) because of call-blocking of 1-800 numbers.
o The plan uses the ED data to offer members an opportunity to participate in MCO case management.
o There are few urgent care facilities in the New Haven area; hence members turn to the hospital EDs. It was suggested that MCOs might look at their geographic access to walk-in clinics for urgent care only. The concern is over-reliance on walk in centers for episodic care rather than the primary care provider for continuity of care.

Anthem:

• Baseline July 04-June 05, non-emergent ED visits:

o 11% of members had one ED visit,
o 2.4% had 2 visits
o 0.6% had 3 visits
o 0.25 had 4 visits and
o 0.09% had 5 visits, with 0.06% with > 5 visits during that year.

• Visits included both child/adult members, more visits were on Mondays and top diagnoses were ear infections, upper respiratory infections, fevers, pharangitis and unspecified viral infections.

The four plans do implement (voluntary) case management outreach to members, and provider notification of their patients with frequent ED use. The urgent/emergent coding accuracy was noted.

Obesity-related Service Billing Codes
The four plans were asked to clarify acceptable billings codes for each plan for hospital-based obesity-related nutritional services. This information should be available before or for the July 12 meeting.